Revised Laws of Saint Lucia (2022)

Schedule 3

(Section 246)

NOTICE OF ACCIDENT CAUSING DISABLEMENT WHERE DISABLEMENT HAS CEASED

1.     Name of employer     
2.     Workplace and address of workplace     
         
         
3.     Nature of business    
         
         
4.     Branch or department and exact place where accident occurred
         
         
5.     Injured person's—
     (i)     Surname    
     (ii)     Other names    
     (iii)     Address    
     (iv)     Sex    
     (v)     Age at last birthday    
     (vi)     Precise occupation    
6.     Date and hour of accident    
7.     Time injured person commenced work     
8.     Nature of accident     
         
         
         
If caused by machinery–
(a)     give name of machine and part causing accident     
         
         
(b)     state whether machine was moved by mechanical power at the time of the accident 9. Extent of disablement    
         
         
9.     Extent of disablement    
         
         
10.     Date disablement ceased     
         
         
Date:    
    
Signature of Employer